MEDICARE: KEVIN CALLAHAN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070015109	IL

General Provider Information

NPI Number	:	1801836358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN CALLAHAN DPT

Provider Business Mailing Address
First Line	:	201 E OGDEN AVE
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-3633
Country	:	US
Telephone Number	:	630-325-2880
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E OGDEN AVE
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-3633
Country	:	US
Telephone Number	:	630-325-2880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	03/20/2014

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